PRESERVING THE PATIENT REFERRAL PROCESS IN THE MANAGED CARE ENVIRONMENT

Referrals are a central component of the American health care system, defining the relationship among generalists, patients, and specialists . The dynamics of the referral process as they existed in a fee-for-se rvice medical environment will evolve under managed care, but retain t he basic ''Try-out'' approach of the generalist and ''Rule-out'' appro ach of the specialist. A managed care, contract-based health care syst em alters some of the assumptions on which the referral relationship h as been structured. A four-step approach to assuring quality interacti ons among patient, generalist, and specialist within the managed care environment is described, including: (1) engage; (2) anticipate; (3) f eedback; and (4) reassess. When the referral process is structured as suggested, it can be evaluated for quality and efficacy. Armed with mu tual respect and understanding, the forces that polarized specialist a nd generalist care in the 1980s can be redirected to enhancing patient care in the 1990s.